Program Operations Manual System (POMS)

A. Sample form

B. Purpose/Use

This form notice is used to advise a DIB or CDB beneficiary that cessation of benefits
was affirmed upon reconsideration.

This notice does not require any fill-ins.

NOTE: Personalized disability notice procedures implemented July 1, 1981, require that
Forms SSA-4268-U6/C6 be attached to unfavorable disability form notices. In addition
to preparing this form notice according to instructions, the typist must:

1.

Type the personalized and technical rationales on the Form SSA-4268-U6 or SSA-4268-C6.

2.

Prepare appropriate rider (or include paragraphs on form notice if there is room).

3.

Assemble form notice, personalized rationale and the rider stapled together in that
order, with envelope for mailing.